| NPI | 1033445184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD441122) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX N9613) |
| Enumeration Date | 2009-10-26 |
| Last Update Date | 2016-07-28 |